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Clover Health Policies

 

DECLARATION OF DISASTER OR EMERGENCY

If you're affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare-certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction or cost-sharing and waiving authorization) benefit the member.

If CMS (Centers for Medicare and Medicaid Services) hasn't provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

Policy # UM-003

30 Day Readmission Policy

Policy # UM-004

Peer-to-Peer Review

Policy # UM-010

Denials and Terminations

Policy # UM-013

Single Case Agreements

Policy # UM-022

Part C Retrospective Review

Policy # CQI-7

Health Risk Assessment